Changes in management for patients with lung cancer treated with radical radiotherapy during the first wave of the COVID-19 pandemic in the UK (COVID-RT Lung)

Abstract

Background: In response to the COVID-19 pandemic, guidelines on reduced fractionation for patients with lung cancer treated with curative-intent radiotherapy (RT) were published (Faivre-Finn et al) aiming to reduce the number of hospital attendances and potential exposure of vulnerable patients to SARS-CoV-2. Here we describe the changes that have taken place. Methods: COVID-RT Lung is a prospective multicentre UK data collection. Inclusion criteria are: patients with stage 1–3 lung cancer (biopsy-proven or diagnosed on cross-sectional imaging) referred for and/or treated with radical RT between 2/4/2020–2/10/2020. Both patients who had a change in their management and those who continue with standard management are included. Data on demographics, COVID- 19 diagnosis, diagnostic work-up, RT and systemic treatment, treatmentrelated toxicity, disease/patient status are collected. Each participating centre obtains local approval and anonymised data is collected on a central, cloud-based Research Electronic Data Capture system. Results: 1117 records from 20 UK RT siteswere available for analysis on 30/11/2020. 562 (50%) female, median age 72 years (38–93 years). 15 patients (1%) were diagnosed with COVID-19, 9 prior to treatment. 160 patients (14%) had their diagnostic investigations affected by the pandemic. 415 patients (37%) had their treatment changed from their centre’s standard of care (table). Patients with PS0-1 were more likely to have their treatment changed compared to patients with a poorer PS. The median number of RT fractionswas 15 for patients who had their RT dose/fractionation changed compared to 20 for those who were treated as per standard of care. Conclusions: This nationwide cohort shows that clinicians in the UK changed the management of patients with stage 1–3 lung cancer in line with national guidelines. The main changes are a reduction in chemotherapy use and an increase in RT hypofractionation.